Ruminations by a non-academic general surgeon from the heart of the rust belt.

Monday, June 7, 2010

To blog or not to be

I've been struggling lately with the raison d'etre of this blog. I tend to write about a variety of topics, usually medically related, but it seems the best posts have been the ones based on actual patient encounters in my practice. And I've been wrestling with the significance of that fact to such an extent that I had to just shut things down for a while.

Blogging is by nature an extraordinarily solipsistic expression of individuality. It isn't enough for the blogger to privately fill notebooks with his ramblings---no, he must publish them to a world wide audience. It takes a certain degree of pompous audacity, let's be honest, to embark on such a task. One has to believe that what one is writing is unique, interesting, important enough to be read by strangers. I've always hated this implication of blogging. To blog is to cry out for attention.

The stakes are much higher for medical bloggers who go beyond writing about healthcare policy and reform. To write about a meaningful patient encounter is to cheapen it somehow. And I have become increasingly uncomfortable with the exploitative, self-aggrandizing solipsism inherent in writing about patients. I grown tired of Myself and the Voice I provide on Buckeye Surgeon. I'm always constructing these narratives where I'm some super-compassionate doctor of mercy, unique in ability to identify those anecdotal moments of human connection. I'm tired of the narrative, the underlying message of I'm a nice guy and a superb clinician that runs through the thread of posts. The blog dangerously veers toward being more about me and my supposed superior compassion and diagnostic acumen rather than about the patients or functioning as some sort of edifying source of inside medical information. It's irritating as hell. I'm a real person, with real shortcomings and faults. I ought to be writing more posts about how I was rude on the telephone late night with some nurse or how I was impatient with a patient's relative because she kept asking the same damn question over and over or the time I made a delayed diagnosis. It wouldn't be such a glowing portrait of me, but at least it would be an honest one. (But then you ask yourself, why do I even need to be painting accurate self portraits for strangers to peruse on the internet? Wouldn't that hurt my career? Isn't it better to concoct some alternative personality that people can read about on line?)

I feel this blog has unintentionally created a Doppelganger Dr Parks who is always kind and wise and decent, who never makes errors, who always sees the little streaks of humanity glimmering under the veil of illness in his patients. I mean I have tried to write honestly about things over the past three years. I wasn't intentionally trying to manipulate facts. But you cant help writing in such a way that makes you look maybe better than what you really were, in retrospect. In the act of writing, I'm able to capture my life and my experiences in such a fashion that I see myself as an agent of good. That isn't a bad thing I suppose. We all have our private little forms of solace as we navigate through unwieldy, unpredictable life. But a blog isn't private. It ends up being a slanted representation of a real person. I can do the same thing and derive the same benefit in a private journal, just perhaps more honestly and with more perspective.

The one good thing about the blog is that its mere existence has forced me to contemplate my life as a surgeon on a more consistent basis. A blog is always starved for material and the experiences I've had have been a fruitful fodder to fill the hungry beast. My reflections on specific encounters have changed me more than the encounters themselves. But I don't want to keep repeating myself. I don't want Buckeye Surgeon to devolve into a bunch of sappy, regurgitated tales from the front lines of the hospital. That's not what this was supposed to be about. It was supposed to transcend its author, a medium through which author and reader alike could possibly make some sense of illness and death and human fallibility.

One thing I've discovered on these travels is this idea that the patients don't so much need me as I need them. The authenticity of a meaningful patient encounter fills some indescribable void in my life (pathetic as that sounds). I need them. I need the 88 year old guy recovering from a perforated bowel surgery who tells me he prayed last night for the first time in 50 years. I need to see the lonesome mother holding the hand of her prodigal son, suffering in the ICU with severe alcohol-induced necrotizing pancreatitis, whispering for him to open his eyes. I need the brash 77 year old Senior Olympian (diskus and hammer throw) recovering from a bowel obstruction who gives me shit every morning about how I played soccer in high school instead of wrestled. But I don't want to exploit them or splash their vulnerability all over some public blog anymore. Conversely, if I dont write about them, I lose them; they slip from the tenuous realm of my active memory. They strike me like those big beautiful snowflakes in early November that quickly melt and dissipate on your sleeve. I want to keep as many of them frozen and crystalline and perfect for as long as I can. I want to be like that kid in the book Snowy Day who hides a snowball in his pocket, hoping it will be there when he wakes in the morning.

I'm not entirely certain what will happen with Buckeye Surgeon. I'm still grappling.

35 comments:

Hey thats cool, even my favorite President, Richard Nixon quit, and look how he turned out...and I hate these Narsicistic bloggers who have to tell you how great there blog is, like mine, for instance, where just last week I revealed the 3rd Secret of Fatima...Seriously, I feel your pain, because while Soccer is sort of gay, try being a 9th grade Tennis player who traveled with the Baseball AND Wrestling team...and it didn't matter that I played baseball too, didn't keep em from givin me an Atomic Melvin, which really sucked when you remember those tight tennis shorts that were in style back in the 70's... and when you feel depressed, just go down to Jacob's Field and take in a good Ball Game...HAHA! seriously, only 12 weeks till Ohio State underperforms again...

I stumbled upon your blog last summer while looking up "thyroidectomy". "A fun little operation" I think is how you characterized it. Oddly enough that reassured me that while it might seem like a major life-changing event to me, to the pros it was all part of a day's work - something very do-able, and to be done with professionalism. It would be okay. (And it was okay)I have enjoyed reading your posts and have not come away with the impression that you have an inflated opinion of yourself or that you are "using" your patients, rather that you and probably md's generally care bout doing a good job. I hope you don't stop blogging.(only one problem - I've started visiting Frank D's site too, it's curiously addictive. Please keep blogging for our balanced reading!)

I will read whatever you want to write. Whenever you want to write. Your wordsmithing and thought-provoking blogs have made me think, laugh, puzzle, contemplate, and sometimes laugh-out-loud in my cubicle. Hoping you will continue, fellow Buckeye, whenever the spirit moves you and the story needs to be written.Peggy, RN, in Ohio.

I am incredibly sensitive to the issues you touch on here and why its difficult to blog about our profession - I couldn't agree more with the justifiable self-doubt and apprehension you express (hell, I don't blog about my day at work for some of the same reasons you touch on). However, from a purely self-interested position: please don't stop. As a current surgery trainee, I actually consider yours to be one of the voices I hear in my head that motivates me to be a better practitioner and holds me to a higher standard. This despite the fact that I've never met you, and even if, as you point out, you may present an aggrandized version of yourself for me to get to know. Because at the end of the day, it doesn't matter. Why do people go to church? To hear the same stories again?, because they already know all the stories. I would like to think that ts because living up to a standard is hard, and people may need to be reminded what this is all about to keep motivated, and I feel that's what this kind of medical writing, when its good, has been for me and what it might be to other people. We may often get distracted by health care policy, billing woes, malpractice, whats new on chromosome 11q yadda yadda yadda, but its spiritually fulfilling to get that reminder, which you have been so kind as to provide me, of why we care so much to do what we do in the best way we know how to do it. So please don't write anything like this ever again.

Side story: I was on a particularly spirit-crushing rotation when David Foster Wallace died and you posted about what his writing had meant to you and how lessons you had taken from his perspective had a profound impact on how you experienced some of what happened to you at work. I had never read anything by him before, but I was very moved with what you had written and so I made a quick trip to the used bookstore to fix that and have been grateful ever since.

Yes, please don't stop. You are one of my favs....why, because you are real. I sense your feelings when you talk about certain patients. We all need to feel connected and your writing makes me think I'm right there next to you making rounds. You make me feel like the young RN I was instead of the 71 year old I am now. I've been checking everyday to see if you have posted...please don't stop. In addition to the 'feeling' part of your posts.....you are a great teacher. I learn and relearn from your postings.

Your musings have brought insight and changed my thoughts on my own patient care, so yes you do transcend the self sometimes and meet the reader at some higher actualization.

So grapple with blogging, and then continue with the creativity that writing allows you. Bring us to new thoughts at deeper levels. And I challenge you to be real. Write truth and irony and all that is healthcare today. And work on not being rude to RN's in the meantime:)

You gotta listen to your muse. If you're not into the writing, there's no obligation and forcing it is not beneficial. On the other hand, you are good at it and I very much enjoy reading your stuff, so I hope you find it in yourself to keep at it.

Blogging doldrums happen. Been there more than once. Take a walk (which you already sort of did) and see if the gusto comes back.

Also remember the fall-back of the lazy blogger: linking. Link to me, link to Bongi, link to whoever you read and thought "that was pretty good." And when the next good case or good story comes by you have a little bit of momentum to put a good post together.

Hope you keep at it; if not be sure to drop by and say hi from time to time.

Such a great blogger to quit. I happened to stumble on your blog today and I'm saddened because even as a fresh reader of your blog I know you will be a great loss to the blogger community and even men and women in hospital scrubs who are reading your posts will gonna be frustrated. Hope you continue writing posts on this blog. Yeah blogging has disadvantages but it has also so many benefits eh.

I sincerely hope that you keep blogging. I find your writing very entertaining, although I suppose that when you start to second guess yourself, it seems to be the beginning of the end of the blog. Besides, I never realised that surgeons were so thoughtful, maybe it was just their sleep deprived personas who I met.

Also: there's nothing wrong with needing your patients. None of us lives in a hermetically sealed vacuum. Everyone needs things to survive. The car mechanic needs damaged vehicles, regardless of the drunken tragedies that led them to his shop. The dry cleaner needs dirty clothes, regardless of the rowdy circumstances that stained them. In fact, what higher calling than to "need" other people to suffer (which they always will anyway) for the express purpose of relieving it. Nothing mundane about that. I'd call it noble.

I have honestly spent some significant effort trying to think of something intellectually compelling to say. I have failed. So, I will fall back on a couple simple statements.

One - you are a surgeon writer. I look forward to everyone of your posts (and I don't agree with everything you say... but you say it well and with logic). Without your words in print, I am left with Atul Guwande's drivel. Thanks.

Two - There is no reason why you can't be a self-promoter. As long as its the truth. Its all about truth. It is well known that you are not anyone else's priority - therefore, you need to be you're own - there's nothing wrong with that.

My first impression of your recent comments is that you are way too hard on yourself.The good and better than good physicians I have known and worked with over the years all seem to be that way.I hope I was.

I vote you keep blogging particularly about the times that you "made a delayed diagnosis." Make sure to post within the statute of limitations, and include the name and phone number of the patient. Thanks.

Oh, for Pete's sake. What you write in a blog is really no more meaningful than you say in a conversation. It's not very likely that students and wise men centuries hence will be studying your blog for insight into the secrets of the universe and debating over whether you reveal the truth or The Truth.

What happens is that you, in essence, issue a standing invitation to join you for a cup of coffee and a chat, and a lot of us accept that invitation because we enjoy these chats. We even bring our own coffee. You tell us what's on your mind. We respond in whatever way we choose. Maybe we leave a comment. Maybe we tell someone we know, over a cup of REAL coffee, "So I was reading this blog the other day...". Maybe we just nod to ourselves and go on with life. But that's all we expect the transaction to be -- an interesting story you tell over coffee.

As long as you feel you have stories to tell, tell them. You're an interesting guy, you write well, and I'll bet you will always have an audience.

Although I do not have a medical background, I do enjoy reading your blog. Whether you are explaining a rather interesting procedure or talking about someone that made a deep impression on you --- your compassioin for your profession comes through. I am a faithful reader.

first of all if you were really a solipsist, someone who believes the self is the only real thing existent, then why would it matter whether you wrote it down in a notebook, or published it on the internet? it would be the same result either way. (aren't you going to miss snarky usage corrections?)

second, your patronizing your readers. We're cynical and able to identify saccharine tripe for what it is. You write; we internally criticize; we praise; and we enjoy your writing.

Honestly the most aggrandizing thing i've read on your site was this post.

Thanks for laying out these issues. Those of us who have tried to write about our work run into them every time, at least we do if we are honest with ourselves. One of the first books about being a doctor was Dr. X's Intern. The reason it was, and still is, so good is that it does include the times Dr. X and his resident did the wrong thing. Times when the patient died, times when he refused to go see the patient yet again, times when all hell broke loose and he had no idea what to do. (Fortunately the nurse did.) Please find a way to keep talking to us. Some of us need you, very much.

By the nature of writing -- a given point of view at a particular point in time -- one builds a Doppelganger. I'm not in medicine, but I've enjoyed many of your entries, and have not found them to be false, manipulative or self-aggrandizing. Continue if it satisfies something, or don't, if it has run it's course for you.

Some people just have to write... the muse is upon them. The fact that you are a surgeon does not make you any less a writer. I found that the main problem with writing is when your readers know who you are. Then, you become defensive with your words and thoughts, the sparkle leaves your keyboard and your literary juices become a veritable Saraha. Don't quit...take a respite, because someday (hopefully soon) there will be an ocean of words just waiting to spill out. Your readers will be here, because we need to read as badly as you need to write.

Subscribe

Disclaimer

1. The cases and stories described on this blog are a fictional creation of the author. Many "facts" gleaned from the author's experience as a general surgeon have been altered for instructional and literary purposes. In no way are any of the stories told on this blog non-fictional accounts of actual patients.

2. By entering this blog, you agree to acknowledge that the author does not provide any medical advice and any medical information obtained from the blog is in no way a substitute for an evaluation by real health care professional.

3. Any opinions of the Author on the Site are or have been rendered based on specific facts, under certain conditions, and subject to certain assumptions, and may not and should not be used or relied upon for any other purpose, including, but not limited to, for use in or in connection with any legal proceeding.

4. The Site is protected by United States copyright laws. The Author hereby reserves any and all intellectual property rights in the Site.

5. Courtesy is expected when you decide to post comments. Be nice. Act like a jackass and I'll have to delete you.